Hepatitis A outbreak reported in Orange County among homeless, drug users

Eduardo Contreras / AP

File photo. In this Sept. 1, 2017 photo, a worker tapes signage telling people to get vaccinated to protect themselves against hepatitis A on hand washing sinks installed at the Neil Good Day Center in downtown San Diego.

File photo. In this Sept. 1, 2017 photo, a worker tapes signage telling people to get vaccinated to protect themselves against hepatitis A on hand washing sinks installed at the Neil Good Day Center in downtown San Diego. (Eduardo Contreras / AP)

A record number of hepatitis A cases have been reported in Orange County this year, prompting health officials to urge residents to get vaccinated against the virus.

The 53 hepatitis A cases this year represent a large increase from the previous five years, when the county recorded between zero to 10 cases annually, health officials said.

What’s also concerning is that the majority of the cases this year have been transmitted locally — only seven cases were in travelers. In contrast, six of the 10 cases last year were in travelers.

“This is probably the tip of the iceberg,” said Alvina Chu, an epidemiologist at the Florida Department of Health in Orange County. “Some people may have gotten sick and recovered without going to the doctor.”

The number of cases has been steadily increasing in Florida, from 122 cases in 2016 to 276 cases in 2017, and 280 cases as of Oct. 20 this year, according to data from the Florida Department of Health.

Pinellas and Hillsborough counties recently issued advisories similar to Orange County, encouraging residents to get vaccinated.

This is probably the tip of the iceberg. Some people may have gotten sick and recovered without going to the doctor.— Alvina Chu, an epidemiologist at the Orange County health department

The Hepatitis A is a highly contagious liver infection caused by the hepatitis A virus, which is transmitted through contaminated food, dirty needles used for injecting drugs or sexual contact with an infected person.

Symptoms include yellowing of the skin and eyes, fever, fatigue, loss of appetite, abdominal pain and dark urine.

The infection can cause mild illness lasting a few weeks to a severe illness lasting several months. Most people recover completely without lasting liver damage, but hepatitis A can also lead to liver failure and death in rare cases, according to the CDC.

Because the infection is caused by a virus, treatment usually involves supportive care such as rest and fluids. It can take several months for people with Hepatitis A to start feeling better, according to the CDC.

Homeless people, those who inject illicit drugs and gay men are at the highest risk for getting infected with hepatitis A.

In Orange County, the majority of the locally transmitted cases are in young white men. The cases are spread across the county, although there’s a noticeable concentration in the western part of Orange County, according to the health department.

About one-third of the cases involve homeless people. More than 70 percent are individuals who inject or use illicit drugs. About 34 percent are gay men.

Dr. Ira Longini, professor of biostatistics at the University of Florida, said this outbreak doesn’t put the general population at risk because it doesn’t involve food contamination.

“Vaccination is the quickest way [to prevent infection],” said Longini.

Two doses of the vaccine are recommended. You can getthe vaccines for $76 at the health department. People without health insurance can get the vaccine for free.

The health department is also working with homeless coalitions in the county to vaccinate homeless people.

Chu said health officials have been contacting infected individuals and vaccinating people with whom they might have had contact. But the task could get challenging when the infected person is homeless or a drug user who doesn’t want to be reached.

ROBYN BECK / AFP/Getty Images

Hepatitis A is a preventable infection because there's a vaccine for it.

Hepatitis A is a preventable infection because there's a vaccine for it. (ROBYN BECK / AFP/Getty Images)

Officials also stressed the importance of hand-washing to reduce the risk of food contamination and further spreading the virus.

“The spillover to the general population is something we want to prevent,” said Chu.

The Advisory Committee on Immunization Practices for the first time recommended routine vaccination of homeless people this year to prevent outbreaks of the disease.

Also, part of the opioid bill that was signed into law by President Trump on Wednesday helps gives the CDC $40 million a year to help state and local government to track, test for and prevent opioid use-related infectious diseases including viral hepatitis.

Twelve states reported more than 7,500 hepatitis A infections from January 2017 to October 2018, according to the CDC. Homeless individuals, people who use injection or non-injection drugs and those who come into close contact with them make up the majority of the cases.

For more information, contact Orange County health department’s Hepatitis Prevention Program at 407-723-5054.